Piriformis Syndrome – A Pain in the Butt


Disclosure: This post is sponsored by MELT Method, and authored by its founder, Sue Hitzmann. Tune in to learn a LOT about addressing your piriformis issues once and for all.




What is Piriformis Syndrome?

Piriformis syndrome is a collection of symptoms that are frequently misdiagnosed, thus prolonged and a key cause of more symptoms as the lack of treatment progresses. Often times misdiagnosed as sciatica, also called sciatic neuralgia or lumbar radiculopathy, piriformis syndrome has more to do with muscular imbalance, whereas sciatica is caused by general nerve compression in the region of the mid lumbar spine and sacral regions.

Why are Sciatica and Piriformis Syndrome so often misdiagnosed?

The reason these two very painful syndromes are misdiagnosed is a two part issue. First, their symptoms are very common such as:

  • Lower back and buttock tightness and pain
  • Burning or radiating pain through the legs
  • Lower back ache
  • Discomfort while sitting
  • Pins and needles sensations or tingling throughout the leg
  • Difficulty walking or controlling the leg motion through gait


The second issue is that, for both conditions, pain is caused by sciatic nerve compression however upon examination by a doctor using MRIs and x-rays, piriformis syndrome won’t necessarily be evident on these image tests, and no clear or accurate test for the condition currently exists. Sciatica on the other hand is diagnosed when a doctor finds a direct relationship to an identifiable physical issue like a herniated disc, lower lumbar degeneration, and even progressive scoliosis.

Sciatica + Piriformis Syndrome: The Worst of Both Worlds?

Not to make matters worse, but some patients suffer from both sciatica and piriformis syndrome.

Additionally, many people have a herniated disc or bulging discs that are found on an MRI, yet they may not be the cause of the symptoms listed above.

Research shows 1 person in 7 has a sciatic nerve that passes straight through the piriformis muscle (one of five key external rotators of the femur) and over time, repetitive postures and movements cause this and the other external rotators to become hypertoned and contracted. This can result in the symptoms listed above. 

How do I find out if I have Piriformis Syndrome?

As of today, there’s not a single test that is specific for piriformis syndrome. This causes a major problem with the clinical diagnosis. Therefore, a precise and reliable clinical method of diagnosing piriformis syndrome should be developed by clinicians. In my practice, a basic hands-on test called FAIR (flexion, adduction, internal rotation) combined with other hands on techniques has offered me simple ways to avoid undertreating this particular issue and also hone in on both possible disorders – piriformis syndrome and sciatica at the same time.


What is the treatment for Piriformis Syndrome?

Although therapists have many ways to help their clients alleviate pain in the short term, what I’ve found most effective at keeping the symptoms at bay and resolving the imbalances is daily self-care.

For Piriformis Syndrome most specifically, our repetitive lifestyles are what cause this issue most often. For example, my runners and cyclists who develop this syndrome also have real life job where they sit all day long. This posture causes the core system that stabilizes our spine and pelvis to neurologically fall weak. This causes our body to compensate, to manage the balance of our torso and pelvis over our feet when we get up to walk. And THIS causes excessive contracture in the upper gluteal muscles and the external rotators — which leads to more compensation and ultimately pelvic pain and syndromes such as this.

Adding insult to injury, after sitting all day causing these compensatory patterns, these athletes get right up and go for their run or ride, which again, leads to faulty recruitment patterns causing even more issues for their low back, knees and of course that shooting pain in the buttocks.

Self-Care Treatments for Piriformis Issues.

The secret to really eliminating this syndrome is NOT going directly to the area where you have pain. As a therapist, the last thing I would do is jam my elbow in someone’s butt to alleviate this disorder. Instead, I work to improve core timing, mobility of the pelvis and then re-establish hip positioning and then muscular timing. It’s a recipe that has worked time and again and the good news is, you can do it to yourself!


It’s a process that doesn’t have instantaneously or magical results overnight but over the course of two weeks, the pain reduction and process to regain balance and control, eliminate compensation and improve performance is achieved. Adding to this, once the pain dissipates, the process to keep our pelvis in good alignment, and muscles in peak condition can be maintained using the same protocols. There are 2 key MELT Sequences – The Lower Body Compression Sequence and the Lower Body Length Sequence that restore our overall pelvic and core stability then 2 MELT Performance Sequence – NeuroCore Sequence and Lower Body Stability Sequence that can be mixed and matched to reintegrate the timing and control of our pelvic stabilizers and repattern proper movement of our hip joint. On the new MELT on Demand, you can find not only these sequences, but MELT Maps for pelvic pain where I put the sequences into one stream you can follow at home, and do it on your own.


Don’t let Piriformis Syndrome be your pain the butt. Keep your body stable and restore proper function so you can walk, run, hike, bike and live your life like your inner athlete deserves!

Meet your new best friend, Sue Hitzmann.

Ok, now THIS part of the post is written by us – the FitFluential Team. And we want to tell you why we know that Sue Hitzmann is going to become YOUR bestie. Sue is the founder of MELT Method. And when you head over to her site, you are going to discover the MECCA of all things pain management related, all things from books to portable (yet effective and safe) equipment and streaming video tutorials– all designed by Sue, who knows everything there is to know about FASCIA (don’t think you know it all, you probably don’t, this woman is a genius!!)  and how to re-hydrate your fascia to eliminate chronic pain and improve your mobility and performance. BUENO. Am I right? Trust me, we are spot on. 

First of all, Sue is the author of not one but two books– the first is The MELT Method book.

Her newest book, MELT Performance (are you excited yet– you runner/marathoner/triathlete person, you!) is now available for pre-order- and tune in, she’s touring the country so if you are interested in meeting Sue and attending a free class– be sure you leave a comment below so we can invite you when she hits your town! 

Next up– you’ll find a selection of all the tools Sue teaches you how to use, to administer the MELT Method- on your own, at home, or on the road (in your own hotel room if you want!). You see, the MELT Method is just that, (our words) – a self-care or self-treatment practice using minimal equipment, done in the privacy of your own home, to manage your chronic pain issues and prevent future injury and improve your overall mobility and performance. 

BAM. Do you see why we love this woman? She is so SO SMART about our bodies and the unique problems that happen to us based on our lifestyle in corporate america or our lifestyle competing in crossfit. Or anywhere in between. 

Bottom line is, we all love to work out and eat right but the one thing that often evades us is- how do we deal with the aches and chronic pains that come with our active lifestyle? MELT Method is the antidote. 

Sue has a streaming video subscription service under $20 a month that includes TONS of customized treatment sequences for all the possible aches and pains you can imagine. 

WE KNOW that so many of you tend to rely on going OUT to a practitioner like a chiropractor or bodyworker or sports therapy specialist, when you could be treating yourself, on your own, saving time and money by implementing the MELT Method. 

We dare you to test this out and not be incredibly impressed. Now, get on over to the MELT Store  and grab a bundle of her MELT equipment, you don’t need a lot and you are set. Then may we strongly recommend getting her books AND subscribing to MELT ON DEMAND?? 

Let us know what your most common recurring pain is from running, and we’ll be sure Sue addresses that in her next post with us! 

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